1402. National Trends in Neurosurgical Healthcare Utilization of Neurofibromatosis 1 Patients

Authors: Jun Hui Lee; Isaac Freedman, MPH; Andrew Koo, BS; Osama Ahmed, BS; Anthony Ma, MS; Michael DiLuna, MD; Jacky Yeung, MD (NEW HAVEN, CT)

Introduction:

Neurofibromatosis type 1 (NF1) is one of the commonest syndromes, occurring in roughly 1 out of 3500. This study examined the recent trends in the national healthcare utilization by NF1 patients, especially in neurosurgical care.

Methods:

In this multi-year cross-sectional study, all patients in Nationwide Inpatient Sample database with diagnosis code for NF1 were queried from 2010 to 2015. Demographic and hospital characteristics were summarized and compared between years. Proportion of common neurologic diagnoses and neurosurgical procedure were also compared. The length of stay, in-hospital death, discharge disposition, and total charge/cost of admission were the main outcomes.

Results:

This study included 4726 patients with NF1 diagnosis between 2010 and 2015. Over the years, there was an increase in the proportion of Caucasian patients (51.7%-56.5%) and decline in proportion of black (20.6%-16.8%) patients (P<0.001). The proportion of patients covered through Medicaid (33.1%-38.0%) increased significantly (P<0.001). Gradually higher proportion of patients were treated in Northeastern, small/medium, or urban teaching hospitals. Correspondingly, gradually less patients were treated in Southern, large, or rural/urban non-teaching hospitals. (all P<0.001) The frequency of scoliosis (8.8% - 11.7%, P=0.03) and neuro-oncological disease (11.3%-13.6%, P<0.001) increased, but the rate of spinal fusion, cranial/peripheral nerve procedure and craniotomy did not change. There were no differences in length of stay, mortality, discharge disposition and charge/cost of admission over the years.

Conclusion:

There appears to be ongoing changes in demographic, hospital and insurance characteristics of NF1 admissions. The rises in prevalence of neurological diagnoses have not led to increase in surgical intervention. The overall admission outcomes including mortality and cost do not seem to have changed significantly from 2010 to 2015.